By LOIS BAKER
Persons with multiple sclerosis who smoke risk increasing the
amount of brain tissue shrinkage, a consequence of MS, and the
subsequent severity of their disease, new research conducted at
UB's Buffalo Neuroimaging Analysis Center (BNAC) has shown.
The results are based on magnetic resonance images (MRIs) of
smokers and nonsmokers in 368 MS patients treated in UB's Jacobs
Neurological Institute, the university's Department of Neurology
in its School of Medicine and Biomedical Sciences.
Results of the research were presented recently at the 23rd
Congress of the European Committee for the Treatment and Research
in Multiple Sclerosis in Prague, Czech Republic.
"Cigarette smoke has many properties that are toxic to the
central nervous system, and cigarette smoking has been linked to
higher susceptibility and risk of progressive multiple
sclerosis," said Robert Zivadinov, professor of neurology,
director of the BNAC and first author on the study.
"Interactions between cigarette smoking and genetic and
immunologic factors may point to mechanisms in disease
pathogenesis. No previous studies have investigated differences in
MRI characteristics between MS cigarette smokers and MS
nonsmokers," he said.
The study included patients from the three most common forms of
MS: 253 had relapsing-remitting MS—acute attacks with full or
partial recovery; nine had primary-progressive MS—steady
worsening from onset; and 90 had secondary-progressive MS,
characterized by occasional attacks and sustained progression.
Another 16 participants had experienced their first MS onset.
Patients ranged in age from 35-55 years and had been living
with MS for an average of 13 years. The Expanded Disability Status
Scale (EDSS), an average number derived from measures of various
functions of the central nervous system based on scales ranging
from 0 to 10, was 3.1. The higher the number, the greater the
Within the study cohort, 128 had a history of smoking: 96 were
active smokers who had smoked more than 10 cigarettes per day in
the three months prior to the study start and 32 were former
smokers who had smoked cumulatively for at least 6 months sometime
in the past. The remaining 240 participants had no active smoking
The average smoking duration was 17.6 years and the average
number of cigarettes smoked per day was 17. There were no
significant differences between smokers and nonsmokers based on
age, disease duration, disease course and total lifetime use of
Analysis and comparison of the MRIs from smokers and nonsmokers
showed that the smokers had significantly higher disability scores
and lower brain volume than the nonsmokers. There also was a
significant relationship between a higher number of packs per day
smoked and lower volume of the neocortex, the portion of the
cerebral cortex that serves as the center of higher mental
functions for humans.
There were no significant differences in any of the clinical
findings between active and former smokers.
"Smoking appears to influence the severity of MS and to
accelerate brain atrophy and the disruption of the blood-brain
barrier in MS patients," said Zivadinov. "MS patients
should be counseled to stop smoking, or at least to cut down so
they can preserve as much brain function as possible."
Additional researchers on the study, all from the BNAC or the
JNI, were Milena Stosic, Nadir Abdelrahman, Barbara E. Teter,
Frederick E. Munschauer, Sara Hussein, Jackie Durfee, Michael G.
Dwyer, Jennifer L. Cox, Nima Hani, Fernando Nussenbaum and Bianca